ICP与妊娠期CHB伴胆汁酸升高的围产结局比较

发布时间：2019-02-11 17:24

【摘要】：目的:比较妊娠期肝内胆汁淤积症(ICP)和妊娠合并慢乙肝孕妇胆汁酸升高病例的生化指标及围产结局,以期为临床提供参考。方法:回顾分析2013年12月到2015年11月在上海市公共卫生临床中心妇产科产检并分娩的262例孕妇的病例资料,ICP组116例,妊娠合并CHB孕妇合并胆汁酸升高组146例,比较两组的生化指标和围产结局。结果:单纯性ICP组与妊娠合并CHB组在总胆汁酸最高状态下指标无明显差异,经治疗后生化指标均明显好转,但ICP组的转氨酶水平仍明显高于CHB组。两组的胎儿胎窘发生率分别为23.28%和14.38%,羊水胎粪污染发生率分别为34.48%和16.44%,发生早产比例分别为43.1%和19.86%,LGA发生率分别为9.84%和2.1%,差别均有统计学意义(P0.05)。结论:单纯性ICP与妊娠合并CHB经积极治疗均得到明显改善。单纯性ICP的病情监测中,除胆汁酸外,还应重视转氨酶变化。合并胆汁酸升高的CHB孕妇如治疗效果良好,可在密切监测下适当延长孕周。
[Abstract]:Objective: to compare the biochemical indexes and perinatal outcomes of intrahepatic cholestasis of pregnancy (ICP) and pregnant women with chronic hepatitis B (CHB). Methods: the data of 262 pregnant women in Shanghai Public Health Clinical Center from December 2013 to November 2015 were retrospectively analyzed. There were 116 cases in ICP group and 146 cases in pregnant women with CHB combined with elevated bile acid. Biochemical indexes and perinatal outcomes were compared between the two groups. Results: there was no significant difference between simple ICP group and pregnancy combined with CHB group under the highest level of total bile acid. After treatment, the biochemical indexes were improved obviously, but the level of transaminase in ICP group was still significantly higher than that in CHB group. The incidences of fetal distress were 23.28% and 14.38%, the incidence of meconium pollution in amniotic fluid were 34.48% and 16.44%, the rates of premature delivery were 43.1% and 19.86%, respectively. The incidence of LGA was 9.84% and 2.1% respectively, the difference was statistically significant (P0.05). Conclusion: both simple ICP and pregnancy with CHB are improved by active treatment. In the condition monitoring of simple ICP, the change of aminotransferase should be paid more attention to in addition to bile acid. Pregnant women with elevated bile acid can be treated well with CHB, which can prolong gestational weeks under close monitoring.
【作者单位】：上海市公共卫生临床中心妇产科;
【基金】：上海市卫计委面上项目资助(No:201540179)
【分类号】：R714.255

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